Provider Demographics
NPI:1962555334
Name:FANARAS, CHARLES JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOHN
Last Name:FANARAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GRANITE PL STE 200N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3271
Mailing Address - Country:US
Mailing Address - Phone:032-236-3111
Mailing Address - Fax:
Practice Address - Street 1:125 N MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4921
Practice Address - Country:US
Practice Address - Phone:603-224-9591
Practice Address - Fax:603-226-7100
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2408OtherNEW HAMPSHIRE BOARD OF PHARMACY